Jordan A Bilezikian, MD, Irene L Israel, MD, William F Powers, MD, William B Hooks, MD, William W Hope, MD. New Hanover Regional Medical Center
Mesh fixation in ventral incisional hernia is a topic of ongoing debate. Permanent and absorbable tacks are acceptable and widely used methods for mesh fixation. The purpose of this study was to compare outcomes of permanent tack fixation versus absorbable when used alone or with suture fixation in laparoscopic incisional hernia repairs.
A retrospective review of all patients undergoing laparoscopic ventral hernia using tack fixation (absorbable/permanent) alone or in conjunction with suture fixation was queried from the AHSQC database. Outcome measures included hernia recurrence rate, pain, quality of life, wound related issues, and hospital length of stay. Propensity match scoring was performed to compare patients undergoing tack only fixation versus tack and suture fixation with a p-value of <0.05 considered significant.
A total of 804 patients were identified after propensity match scoring with 402 who underwent repair with permanent tacks alone or with sutures and 402 who underwent repair with absorbable tacks alone or with sutures. Following matching there were no differences in BMI, Age, Hernia Width/Length, or baseline pain/quality of life. There were no significant differences found in outcome measures including recurrence rates, pain and quality of life outcomes at 30 days, 6 months, and 1 year, surgical site infection (SSI), and postoperative length of stay (p>0.05). There was a significant increase in any post op complication in the permanent tack fixation group compared to the absorbable tack fixation group (21% vs 14%, p<0.0003) which is likely due to the increase in surgical site occurrences noted in the permanent tack fixation group (14% vs. 10%, p<0.005).
Based on this large data set, there are no significant differences in postoperative outcomes in permanent versus absorbable fixation in laparoscopic hernia repair except in surgical site occurrences. Further study is needed to evaluate but at the present time, there is no convincing evidence that one type of fixation is superior to another in laparoscopic ventral hernia repair.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87908
Program Number: P026
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster